Various embodiments are directed to multifunctional surgical devices and methods of using the same.
In endoscopic, laparoscopic, and other noninvasive surgical techniques, internal suturing or other tissue fastening must be performed with instruments small enough to fit through a trocar or endoscope working channel, which can often be quite narrow. For example, the working channel of a typical flexible endoscope has a diameter in the range of about 2.5 to about 4 millimeters. Current staplers and suturing devices cannot be easily redesigned to work through such small openings. In addition, performing procedures by way of the working channel does not easily permit using two instruments positioned at different angles with respect to the wound site in order to “pass and catch” a needle and apply sutures.
Various clips, suture fasteners and anchors have been developed such that clinicians may endoscopically close tissue perforations resulting from, for example, ulcers, polypectomy, incisions, etc. One type of suture anchor is known as a “T-tag” fastener. The T-tag is a small metallic pin with a suture attached at the middle. The physician may load the T-tag into the end of a cannulated needle of an applicator that may be inserted through the working channel of an endoscope. The physician may push the needle into the tissue near the perforation and implant the T-tag into the tissue with the attached suture trailing through the working channel and out the proximal end of the endoscope. After two or more T-tags are attached to the tissue near the wound in this manner, the physician may pull the sutures to appose the tissue around the wound. The physician may then fasten the sutures together by applying a plurality of alternating, right and left overhand knots using a knot pushing device or by applying a knotting element or other type of fastener through the working channel of the endoscope.
FIGS. 1-5 illustrate an example procedure for repairing a wound, such as a gastric bleeding ulcer in the stomach wall of the patient, through a working channel of an endoscope. FIG. 1 illustrates a flexible endoscopic portion 16 of a gastroscope 14 inserted into the upper gastrointestinal tract of a patient. As shown in FIG. 2, the clinician (e.g., gastroenterologist) inserts a suture anchor applicator 18 through the gastroscope 14 and penetrates a cannulated needle 19 through the stomach wall near the diseased area or wound. The needle 19 contains at least one suture anchor such that, as shown in FIG. 3, the physician may deploy a first suture anchor 20 attached to a first suture 24 to one side of the wound and a second suture anchor 22 attached to a second suture 26 to the opposite side of the wound. The free ends of the first and second sutures 24, 26 may extend through the proximal end of the gastroscope 14 such that, as shown in FIG. 4, the physician may draw the first and second sutures 24, 26 together to appose the tissue around the wound. The physician may then fasten the first and second sutures 24, 26 together by knotting them, or using a knotting element or fastener. FIG. 5 illustrates an example knotting element 28 applied to sutures 24, 26. Excess suture may be trimmed near the knot using an endoscopic cutting instrument.
An issue typically associated with current suture anchor applicators, such as those described in FIGS. 1-5, is the risk that nearby organs may be accidentally injured by the needle 19 of the applicator. The physician normally cannot see anatomical structures on the distal side of the tissue layers when the needle is being pushed through the tissue layers. Therefore, there is a risk that adjacent organs may be accidentally injured by the penetrating needle.